Oral pre-exposure prophylaxis is effective for HIV preventing HIV acquisition; however, PrEP initiation and continuation among adolescents and young adults (AYAs) in sub-Saharan Africa remain suboptimal despite ongoing scale-up efforts. This study examined PrEP initiation, 3-month continuation, and associated factors among AYAs aged 15-29 years receiving HIV prevention services in Eastern Uganda from January 2019 to June 2025. Among 10,698 AYAs, 10,132 (94.7%) were assessed for eligibility, 5,190 (51.2%) were eligible, and 2,986 (57.5%) initiated PrEP. Among 2,851 initiators eligible for 3-month assessment, 913 (32.0%) continued PrEP. In multivariate analyses, previous peer outreach contact was strongly associated with both initiation (aOR = 534.63, 95% CI: 276.89-1032.28) and continuation (aOR = 12.41, 95% CI: 9.41-16.35). Facility-based service delivery (aOR = 14.88, 95% CI: 5.05-43.86), psychoactive drug use (aOR = 5.15, 95% CI: 2.97-8.93), and HIV status disclosure (aOR = 4.44, 95% CI: 2.31-8.53) were associated with initiation, while MSM had lower odds of continuation than sex workers (aOR = 0.57, 95% CI: 0.45-0.71). Firth sensitivity analysis produced similar continuation estimates. These findings highlight a substantial gap between PrEP initiation and early continuation, and support sustained peer-based, youth-responsive strategies to strengthen PrEP uptake and retention.
Vertical transmission of HIV remains a significant challenge to maternal and child health in high burden settings. Early identification of maternal HIV status enables timely antiretroviral therapy initiation and helps prevent transmission during pregnancy, childbirth, and breastfeeding. This study explored barriers to HIV testing uptake among pregnant and postpartum women attending antenatal care (ANC) services in Soweto, Johannesburg. A qualitative research design was employed, involving in-depth interviews with ten adult women who accessed ANC services. Data were analysed thematically using Atlas.ti 23 software. Findings revealed multilevel barriers across the socio-ecological spectrum. At the individual level, fear of HIV testing and its potential outcomes discouraged uptake. Interpersonal factors, particularly partner and family influences, shaped women's testing decisions. Institutional barriers included negative healthcare providers attitudes, inadequate privacy, and insufficient counselling. At the community level, stigma amd discrimination discouraged HIV testing, while systematic barriers included gaps in implementing and enforcing HIV testing policies. These findings highlight the need for intergrated interventions addressing individual, interpersonal, community, institutional and systemic barriers. Strengthening confidentiality, improving healthcare provider communications, reducing stigma and enhancing policy implementation may improve HIV testing uptake among pregnant and postpartum women and streghthen maternal HIV prevention services.
Although virally suppressive antiretroviral therapy has transformed HIV into a chronic, manageable condition, people living with HIV continue experiencing elevated depression rates. This study investigated differences in social support and depressive symptoms between men who have sex with men and women, both living with and without HIV. Using data from the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (N = 2,537), depressive symptoms were evaluated via the Center for Epidemiologic Studies Depression Scale and social support via the modified Medical Outcomes Study Social Support Survey. Regression models adjusted for income, age, race, ethnicity, and HIV serostatus. No significant differences between MSM and women in levels of total social support (p = 0.657), instrumental support (p = 0.307), or emotional support (p = 0.901) were found. Women reported significantly higher levels of depressive symptoms than MSM (p = 0.046). Total, instrumental, and emotional support showed strong negative associations with depressive symptoms (p < 0.001). Interaction models revealed that the protective buffering effect of support appeared consistently across groups. Targeted clinical interventions and longitudinal research are urgently needed to bolster emotional and instrumental support systems, particularly for women and lower-income individuals facing disproportionately elevated depression risks.
HIV diagnoses are increasing among women in the UK. Granular data on midlife women's (women aged 40-65 years) knowledge about, and access to HIV Pre-Exposure Prophylaxis (PrEP), an effective chemoprophylactic strategy for HIV, is lacking. Data from a 2024 population health survey of an English city (Brighton & Hove) were analysed to describe the sexual health behaviours of midlife women (cis and transgender), and to investigate whether sociodemographic and/ or sexual behaviour factors were associated with PrEP awareness and use. Among the 3,335 midlife women, 30.4% (1,013) were aware of PrEP and 1.2% (12) had used or were using PrEP. Poor PrEP awareness was associated with older age; heterosexual identity; not living with a long term physical or mental health condition; Asian or Asian British ethnicity; not having received a university-level education; having had fewer sexual partners and never having had an HIV test. National disaggregation of the sociodemographic and sexual behaviour associations with PrEP awareness among midlife women, and an understanding of how this translates to PrEP use is required to enable better targeting of HIV prevention interventions.
